Nurses' Knowledge, Attitudes, Practices and Perceived Barriers to Early Mobilization of Patients in Intensive Care Units in Southeastern Iran.

BACKGROUND

Early mobilization (EM) in Intensive Care Units (ICUs) is a well-established strategy to mitigate complications of immobility, including ICU-acquired weakness, delirium and prolonged hospitalization. Despite strong clinical evidence and guideline recommendations supporting its safety and efficacy-even for mechanically ventilated patients-EM remains underutilized globally. Nurses, as frontline caregivers, play a pivotal role in EM implementation; however, gaps in their knowledge, attitudes and practices, along with perceived barriers, hinder its routine application, particularly in resource-limited settings.

AIM: This study aimed to assess ICU nurses' knowledge, attitudes, self-perceived practices and perceived barriers regarding EM in southeastern Iran.

STUDY

DESIGN

A descriptive-correlational study was conducted in southeastern Iran. Nurses from eight units across three university-affiliated hospitals participated, using a census sampling method. Data were collected via a validated Persian-translated questionnaire comprising five sections: demographics, EM knowledge (21 items), attitude (11 items), practice (12 items) and perceived barriers (12 items). Descriptive statistics, Pearson correlation and multiple linear regression analyses were performed using SPSS v22.

RESULTS

In total, 128 nurses demonstrated moderate knowledge (mean = 10.89/21) and high positive attitudes (mean = 42.32/55) and moderate self-perceived EM practices (mean = 40.99/60). Key knowledge gaps involved mobilizing mechanically ventilated patients and recognizing contraindications. The strongest barriers were patient-related: medical instability and over-sedation. Higher knowledge correlated significantly with more positive attitudes and better practices (p < 0.05). Master's-level education predicted better attitudes, while nursing background and personal EM study predicted improved practice.

CONCLUSIONS

Based on self-reported data, this study suggests a potential disconnect between favourable attitudes and self-perceived EM practices among Iranian ICU nurses, potentially due to knowledge gaps-especially in complex cases-and patient-centred barriers. It highlights the potential need for targeted educational interventions and standardized protocols.

RELEVANCE TO CLINICAL PRACTICE: Findings support integrating structured EM training into nursing curricula and continuing education, developing interdisciplinary protocols and addressing sedation and stability concerns to enhance EM uptake and improve ICU patient outcomes.